You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
Throughout the years I have experienced feelings of anxiety, frustration, anger, and helplessness when dealing with some patients who are commonly described as “difficult.” When discussing such cases with others I have discovered that I am not alone in this regard. As a means of self-preservation together with an attempt to understand the dynamics of this situation I have repeatedly attempted to sort out the possible etiology of this phenomenon. In essence, why is it that the difficult patient is so difficult, and why do they so upset us?
After studying and becoming more involved with psychoanalytic self psychology I have gradually become able to shift my focus in a way that allowed me to see and understand elements of my interaction with such people in a new manner. One of the elements that I found to occur with a greater than average expectancy was a behavior that I can best describe as self-pity.
Webster's (1975) defines pity as “The suffering of one person excited by the distress of another.” The self is defined as “A person or thing, with respect to his, her or its own person, individuality, or identity.” Self-pity might then be defined as: The suffering of a person as excited by its own distress and directed toward its own person, individuality, or identity. While I believe this definition encompasses some common elements of what self-pity is, it does not describe what it does, either as a psychic mechanism within one individual or as an effector of object relations. As I have come to understand it, self-pity is a response to an injury to the self, its purpose is to be self-soothing, reengaging of another, and it is a subtle but potent expression of hostility. The latter is directed both toward the self and the other.
While, like many other psychopathological states, self-pity is a response that everyone has experienced, it becomes a modus operandi or characterological mechanism in those who have experienced significant developmental arrests in what has been desc